Insulin
A 14-year-old with newly diagnosed Type 1 diabetes asks why they need insulin every day. Which response by the nurse best explains the need for lifelong insulin?
A. “You need insulin only when your sugar is too high.”
B. “Your pancreas no longer produces insulin.”
C. “Insulin helps prevent weight gain.”
D. “Insulin is only needed when you’re sick.”
B. “Your pancreas no longer produces insulin.”
Which client is most at risk for developing Type 2 diabetes?
A. A 16-year-old with a BMI of 21
B. A 35-year-old who walks daily
C. A 50-year-old with obesity and a sedentary job
D. A 28-year-old who has Hashimoto's thyroiditis
C. A 50-year-old with obesity and a sedentary job
A patient with Type 1 diabetes presents with abdominal pain, Kussmaul respirations, and blood glucose of 420 mg/dL. What is the priority diagnosis?
A. HHS
B. DKA
C. Hypoglycemia
D. Hyperinsulinemia
B. DKA
Which insulin is appropriate for IV administration during a diabetic emergency?
A. NPH
B. Lispro
C. Regular
D. Glargine
C. Regular
A patient with newly diagnosed Type 2 diabetes is prescribed metformin. Which statement by the patient indicates a need for further teaching?
A. “I should take this medication with meals.”
B. “This medication may cause some stomach upset when I first start taking it.”
C. “I should stop taking metformin whenever my blood glucose returns to normal.”
D. “I should tell my healthcare provider if I develop severe weakness or difficulty breathing.”
C. Metformin is typically taken consistently as prescribed, even when blood glucose improves. It helps decrease hepatic glucose production and improves insulin sensitivity. Taking it with meals can reduce GI side effects such as nausea, diarrhea, and abdominal discomfort.
Which clinical finding would most concern the nurse in a patient with Type 1 diabetes who has missed insulin doses?
A. Bradycardia
B. Cool, clammy skin
C. Fruity breath and deep breathing
D. Swelling in the lower extremities
C. Fruity breath and deep breathing
A newly diagnosed Type 2 diabetic asks why insulin isn't prescribed. What is the nurse’s best explanation?
A. “Insulin is only used in hospital settings.”
B. “Your pancreas is still producing some insulin.”
C. “Insulin would lower your blood sugar too much.”
D. “You only need insulin if you become pregnant.”
B. “Your pancreas is still producing some insulin.”
Which of the following is most characteristic of HHS?
A. Ketones in urine
B. Rapid onset
C. Blood glucose >600 mg/dL without ketosis
D. Acetone breath
C. Blood glucose >600 mg/dL without ketosis
A nurse prepares to give rapid-acting insulin before a meal. When should it be administered?
A. 30 minutes before eating
B. At bedtime
C. Immediately after meals
D. Within 15 minutes of meal start
D. Within 15 minutes of meal start
A patient with Type 1 diabetes uses an insulin pump. The patient reports that the pump has been malfunctioning and has not delivered insulin for several hours. The patient is nauseated, has abdominal pain, and has a blood glucose level of 325 mg/dL. Which complication is the patient at greatest risk for developing?
A. Hypoglycemia
B. Diabetic ketoacidosis (DKA)
C. Hyperosmolar hyperglycemic state (HHS)
D. Hyperkalemia
Diabetic ketoacidosis (DKA)
Rationale: Insulin pumps typically deliver rapid-acting insulin only. If insulin delivery is interrupted, the patient can quickly become insulin deficient, resulting in hyperglycemia and ketone production, which can progress to DKA.
A patient with Type 1 diabetes uses long-acting insulin once daily. What is the purpose of this type of insulin?
A. To lower glucose after meals
B. To cover insulin needs during exercise
C. To provide basal insulin coverage
D. To treat hypoglycemia quickly
C. To provide basal insulin coverage
A client with Type 2 diabetes is prescribed metformin. Which statement by the client requires further teaching?
A. “I’ll take this medication with food.”
B. “This will help my liver release more sugar.”
C. “It might upset my stomach at first.”
D. “I should stop this medication before a CT with contrast.”
B. “This will help my liver release more sugar.”
A nurse is reviewing labs for a client in DKA. Which electrolyte should be monitored closely during insulin therapy?
A. Sodium
B. Potassium
C. Calcium
D. Magnesium
B. Potassium
Which oral antidiabetic class increases insulin secretion and poses a hypoglycemia risk?
A. Biguanides
B. Sulfonylureas
C. DPP-4 inhibitors
D. SGLT2 inhibitors
B. Sulfonylureas
A patient with Type 2 diabetes is admitted with a blood glucose level of 850 mg/dL, extreme thirst, frequent urination, and confusion. The patient has very dry mucous membranes and poor skin turgor. Which intervention should the nurse anticipate first?
A. Administer IV regular insulin
B. Begin IV fluid replacement with 0.9% normal saline
C. Administer IV sodium bicarbonate
D. Restrict oral and IV fluids
Begin IV fluid replacement with 0.9% normal saline
Rationale: HHS causes severe dehydration due to profound hyperglycemia and osmotic diuresis. The priority is fluid replacement to restore circulating volume and improve tissue perfusion. IV regular insulin is also used, but fluids are initiated first.
Which lab value would most support the diagnosis of Type 1 diabetes?
A. Random glucose of 180 mg/dL
B. A1C of 5.6%
C. Positive urine ketones
D. Low HDL cholesterol
C. Positive urine ketones
What is the primary difference between Type 1 and Type 2 diabetes?
A. Type 1 has insulin resistance
B. Type 2 causes diabetic ketoacidosis
C. Type 1 has complete insulin deficiency
D. Type 2 causes autoimmune destruction of beta cells
C. Type 1 has complete insulin deficiency
The nurse knows treatment of both DKA and HHS includes:
A. Oral hypoglycemic agents and corticosteroids
B. Insulin, fluid replacement, and electrolyte monitoring
C. NPO status and antibiotics
D. High-protein, high-fat diet
B. Insulin, fluid replacement, and electrolyte monitoring
A nurse is preparing a patient for a CT with contrast. The patient takes metformin. What is the priority action?
A. Double the dose for better glucose control
B. Administer insulin instead
A nurse is preparing a patient for a CT with contrast. The patient takes metformin. What is the priority action?
A. Double the dose for better glucose control
B. Administer insulin instead
C. Hold the metformin before and after the procedure
D. Encourage fluids and continue metformin
C. Hold the metformin before and after the procedure
A patient with diabetes experiences tremors, diaphoresis, and confusion. The blood glucose is 58 mg/dL. What is the priority action?
A. Recheck the glucose in 30 minutes
B. Notify the provider
C. Administer 15g of fast-acting carbohydrate
D. Give long-acting insulin
C. Administer 15g of fast-acting carbohydrate
Which symptom is most consistent with hypoglycemia?
A. Flushed, dry skin
B. Slow, deep respirations
C. Tremors and anxiety
D. Polyuria and polydipsia
C. Tremors and anxiety
A patient becomes unconscious due to hypoglycemia. What is the nurse's immediate action?
A. Place the patient in Trendelenburg position
B. Administer IM glucagon
C. Offer juice by mouth
D. Start oxygen therapy
B. Administer IM glucagon
A patient asks what puts them at risk for hypoglycemia. Which medication class is the nurse most concerned about?
A. Biguanides
B. Sulfonylureas
C. SGLT2 inhibitors
D. GLP-1 receptor agonists
B. Sulfonylureas
A client asks how to store their insulin pen when not in use. What is the correct response?
A. “Keep it in your purse.”
B. “Store it in the freezer.”
C. “Refrigerate it when not in use.”
D. “Keep it near a sunny window.”
C. “Refrigerate it when not in use.”
A nurse is teaching a patient how to use an insulin pen. Which action by the patient indicates a need for further teaching?
A. The patient primes the pen before each injection.
B. The patient injects the insulin into the subcutaneous tissue.
C. The patient shares the insulin pen with a family member as long as a new needle is used.
D. The patient rotates injection sites within the same general area.
The patient shares the insulin pen with a family member as long as a new needle is used.
Rationale: Insulin pens must never be shared, even when a new needle is attached. Blood can enter the pen's internal components, creating a risk of transmitting bloodborne infections.